Early release, published at www.cmaj.ca on November 8, 2010. Subject to revision.
CMAJ Editorial
The federal government’s senseless policy change
on tobacco warning labels
T
obacco control is an area where government policy
initiatives are uniquely effective in yielding wide-
spread public health benefits. A decade ago, Canada
led the world in enacting tough and effective tobacco pol-
icy regulations, particularly regarding warning labels on
tobacco products. Since then, 38 other countries have
implemented similar programs and many have far more
stringent requirements.
However, rather than moving Canada further ahead, the
federal government now seems poised to abandon this legacy.
In late September, Health Canada abruptly announced at a
closed-door meeting with provincial and territorial representa-
tives that it was suspending plans to move forward with larger
and more graphic warning labels as well as a prominently dis-
played toll-free number for a quit-smoking line. Instead, the
federal government’s tobacco policy will now focus on fight-
ing contraband cigarettes.
Warning labels are an effective, inexpensive communica-
tion strategy. After television, labels are the most important
source of information for smokers and nonsmokers alike
about the adverse health consequences of smoking.1 More-
over, the “dose” of information increases in proportion to the
amount of tobacco consumed: the more often smokers reach
for a cigarette, the more often they see and are influenced by
the warnings. And the tobacco industry is made to pay for it.
Since Health Canada abandoned mass media campaigns
against tobacco years ago, warning labels constitute the fed-
eral government’s only remaining smoking-related mass
communication initiative.
Warning labels make smokers substantially more likely to
notice and read messages about adverse consequences of
smoking, to think about these consequences and about quit-
ting, to forego a cigarette they were about to smoke, and to try
to avoid seeing the labels.2 These cognitive and behavioural
effects are in turn associated with increased rates of quitting
smoking.3 Label messages also inform smokers about effec-
tive strategies to help them quit. Regulations governing the
size and location of warning labels limit the tobacco indus-
try’s ability to use labelling to providing misleading informa-
tion and minimize the risks of smoking. Perhaps most impor-
tant, warning labels effectively deter nonsmokers from
DOI:10.1503/cmaj.101583
starting to smoke and are a key medium for such messages
for vulnerable children and youth.2
The larger and more striking the labels, the more effective
they are. Larger text messages are more successful than
smaller ones, and pictorial warnings are the most effective.1
For this reason, guidelines issued by the international Frame-
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
CMAJ
© 2010 Canadian Medical Association or its licensors
work Convention on Tobacco Control advocate large pictorial
warning labels.2 Canada was the first country to implement
labelling regulations consistent with these guidelines. The
effect on Canadian smokers has been rapid and striking. For
example, knowledge of specific health consequences of
smoking is twice as high among Canadian smokers compared
with their counterparts in the US and UK, where warning
labels do not meet the guidelines.1
The tobacco industry has argued that the existing warning
labels are sufficient, but as usual, they ignore clear evidence
to the contrary. Although warning labels are effective, they
lose their effect over time and with repeated exposure. Coun-
tries such as Thailand and Uruguay have refreshed their labels
three or four times in the past five years. Canada’s labels have
remained unchanged for a decade. In fact, after years of
research and millions of taxpayer dollars, Health Canada has
failed to change a single label.
The Harper government’s sudden policy shift is ill-
conceived. At a minimum, the shift is wasting years of work
and taxpayer dollars. Without warning labels, smoking rates
will rise and eventually result in increased smoking-related
illness and death. Certainly, the problem of contraband must
be addressed. However, there is no obvious reason why fight-
ing contraband should stop the government from proceeding
with new warning labels that have already been developed
and extensively researched.
In the absence of a logical explanation, Canadians should
be forgiven for questioning the government’s motives. Many
have speculated that the government has caved in to the
tobacco industry,4 that undoubtedly sees new and larger warn-
ing labels as a potential threat to its markets and bottom line.
In the past, tobacco companies have spared no expense to
lobby and mount legal challenges to reverse government anti-
tobacco policy. Others may see the policy shift as another
example of the Harper government’s ignoring public health to
focus on a law-and-order agenda.
The federal Minister of Health has previously shown lead-
ership in getting tobacco control legislation passed through
Parliament. Her leadership is needed again. Minister
Aglukkaq must take action to ensure that the new warning
labels go forward without further delay. She should commit
Health Canada to an ongoing process of regular and timely
renewal of the labels, given the clear evidence that this is
necessary. She should also give careful consideration to the
initiatives of other countries that have surpassed Canada’s
lead in fighting tobacco consumption, such as Australia’s
recent decision to require plain packaging of cigarettes.5
1
Editorial
We should all be outraged about the suspension of efforts
to renew tobacco warning labels. Few people — even in
government — would likely dispute the great importance
and high incidence of the often gruesome consequences of
smoking illustrated on cigarette packages. Let us therefore
hope that our elected federal officials hear and heed the
many Canadians whom their senseless policy shift has dis-
appointed and angered.
Matthew B. Stanbrook MD PhD
Deputy Editor, Scientific
Paul C. Hébert MD MHSc
Editor-in-Chief
CMAJ
With the editorial advisory team: Ken Flegel MDCM MSc
and Noni MacDonald MD MSc
2 CMAJ
Competing interests: See www.cmaj.ca/misc/edboard.shtml.
CMAJ 2010. DOI:10.1503/cmaj.101583
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